PFS Clerical Specialist Full Time

Job Title: PFS Clerical Specialist

Classification: Hourly/Non-Exempt

Job Category: 4 - Administrative Support / Clerical

Position Summary

The PFS Clerical Specialist provides essential administrative and technical support to the Patient Financial Services (PFS) department. This role is the primary driver of the document imaging lifecycle ensuring that all physical correspondence insurance documentation and clinical records are accurately digitized and integrated into the hospitals revenue cycle systems. By maintaining a high-speed high-accuracy workflow for scanning and attaching records the Specialist ensures that billing teams have the necessary documentation to secure timely reimbursement and minimize claim denials.

Essential Functions

-High-Volume Document Imaging: Operates high-speed scanning equipment to digitize daily incoming mail including insurance EOBs legal correspondence and patient payments. Performs daily maintenance on scanning hardware to ensure image clarity and prevent downtime.

-Precision Indexing & Attaching: Analyzes digitized documents to identify the correct Patient Name Date of Birth and Account Number. Accurately attaches images to the Electronic Health Record (EHR) and Billing System ensuring that documentation is available to the Back Office team immediately.

-Clinical Document Retrieval: Navigates clinical modules within EPIC or other EHR systems to locate and pull specific medical records (e.g. operative reports pathology results or physician notes) required by insurance payers for claim adjudication.

-Quality Assurance (QA) Review: Audits scanned batches to ensure that multi-page documents are complete legible and oriented correctly. Corrects commingled files where multiple patient records may have been scanned as a single file.

-Mailroom Operations & Distribution: Manages the intake and sorting of all physical mail for the Patient Financial Services department. Categorizes mail by priority (e.g. Appeals Denials Checks) and distributes it to the appropriate billing or collection units.

-Returned Mail & Skip Tracing: Processes Return to Sender patient statements by researching updated demographic information via internal databases or external USPS tracking tools to ensure billing accuracy.

-Fax & Electronic Queue Management: Monitors electronic fax servers and centralized department email boxes routing incoming digital correspondence to the appropriate work queues for processing.

-Record Retention & Compliance: Adheres to strict HIPAA and hospital data security policies. Manages the secure storage of physical documents post-scanning and coordinates the timely secure destruction (shredding) of records according to the hospitals retention schedule.

-Data Entry & Account Updates: Performs basic data entry in the billing system to update insurance addresses payor IDs or patient contact information discovered during the document review process.

-Support for Revenue Integrity: Assists the PB Coding Analysts and Revenue Cycle teams by ensuring that all Additional Documentation Requested (ADR) letters from payers are identified and fulfilled with the correct attachments within 48 hours of receipt.

-Follows and adheres to TRMC vaccine policy(s) mandated by the Centers of Medicare & Medicaid Services (CMS).

Skills/Competencies

-Technical Proficiency: Strong knowledge of document imaging software high-speed scanners and Adobe Acrobat. Experience with EPIC or CAC (Computer Assisted Coding) systems is highly preferred.

-Attention to Detail: Exceptional ability to identify discrepancies in patient identifiers and maintain a 99% accuracy rate in document indexing.

-HIPAA Knowledge: Deep understanding of patient privacy laws regarding the handling and disposal of Protected Health Information (PHI).

-Organization: Ability to manage high volumes of physical paper and digital files simultaneously while meeting daily turnaround deadlines.

Work Experience

-One year of experience in a clerical or administrative role preferably in a healthcare or insurance setting preferred.

-Experience in a Hospital Business Office (BO) or Patient Financial Services (PFS) environment preferred.

-Prior experience with electronic document management systems (DMS) and hospital billing platforms preferred.

Education

-High School Diploma preferred.

Physical Demands and Work Environment

Lifting/Carrying Pushing/Pulling

Lbs. % Time Lbs. % Time

Movement % Time

Bend/Stoop/Twist 1-33

Crouch/Squat 1-33

Kneel/Crawl 1-33

Reach above Shoulder 1-33

Reach below Shoulder 1-33

Repetitive Arm None

Repetitive Hand 1-33

Grasping 1-33

Squeezing 1-33

Climb Stairs None

Walking Uneven 1-33

Walking Even 34-66

Environment % Time

Indoors 67-100

Outdoors 1-33

Extreme Heat None

Dusty None

Excessive Noise 1-33

Equipment % Time

Motor Vehicles None

Foot Pedals None

Extreme Heat None

Dusty None

Excessive Noise 1-33

Work near % Time

Machinery None

Electricity None

Sharps 0-33

Chemicals 0-33

Fumes 0-33

Heights None

Vision

Depth Perception Required

< 20 Required

Color Not Required

Peripheral Required

Endurance Hours at Once Total in 12HR

Sit 1 3

Stand 4 4.5

Walk 4 4.5